Naloxone Is a Key to Safety in Scattered-Site Housing

Pathways to Housing Pennsylvania train staff to use naloxone to prevent opioid overdose deaths around Philadelphia.

Pathways to Housing Pennsylvania uses a Housing First approach to housing and supporting people with behavioral health conditions who have experienced homelessness. They support more than 350 people in housing scattered across the Philadelphia community. Based on a model pioneered by Dr. Sam Tsemberis in New York City, Pathways to Housing specializes in serving people who have not been successfully helped by other services.

The SAMHSA Homeless and Housing Resource Network spoke with Matt Tice, LCSW, a clinical director of a new team serving people with opioid use disorder, about what the team is doing to prevent overdose deaths.

Can you tell me about the new program for serving people with opioid use disorder?

Pathways Pennsylvania has five clinical teams. They all work with people who have opioid use disorder, but our newest team works specifically with the highest-need people. When we are at full capacity, we will serve 60 people. The small size allows us to really focus on their needs. The city’s department of behavioral health (DBH) is trying to prioritize people who are not having success in other types of programs and refer them to us. The need is great. DBH estimates that 150,000 people in Philadelphia need some sort of opioid-related treatment.

Does everyone on your clinical staff receive training on overdose reversal?

We train not only our clinical staff agency-wide, but also our housing staff. Everyone is trained in overdose prevention and carries a naloxone kit at all times. We have done this since last summer when we brought on our new team specifically designed to support individuals with opioid use disorder. It made sense to train not just the new team but everyone in the agency, which traditionally has served many people with opioid use disorder.

The housing staff, who have no clinical duties, are also trained?

Yes, even if someone is going in for a maintenance need or a safety inspection, we want them to have the capacity and training to do a reversal if they need to.

How many times have staff had to use their naloxone kits?

We actually have not had to do any reversals, surprisingly, but our participants have experienced overdoses and reported them to us. We have never come in while someone is in the midst of an overdose. We have had situations where we were monitoring people with a doctor onsite and we did not have to administer naloxone.

Have any participants received training and gotten their own kits?

Yes, for every participant who has opioid use disorder, or even a history of opioid use, we make sure they are equipped. They are trained, we give naloxone to them, and there’s no limit on how often they can get it. There is a pharmacy around the corner that has a great relationship with our participants and staff. If someone has experienced an overdose, we send them right over to the pharmacy so they can get another kit. Not all of these situations are reported to us, but we probably have had 10 people report using naloxone to us. Some resulted in hospitalization and some did not, but these are all situations in which a participant or their peer administered naloxone.

I know that in the Housing First model, people don’t lose their housing for using drugs, but do you think people are scared to report overdoses to clinical staff?

I do not think so because we are very, very clear that it is OK. One of the first things we do with the new team is ask people if they know what naloxone is (most people do), if they have it or have gotten it in the past, and if they are carrying it right now. It is a routine conversation for us. If someone comes from the street, from treatment, or from incarceration, these are all high-risk times. We make safety plans with everyone. We discuss the fact that they might not be used to being around people or that their tolerance may be down, so we discuss how they can increase their safety. We are very open. When people first come in, they are probably hesitant. But those who are used to us know that we want to talk it through and get them support or more naloxone.

How can other housing providers adopt overdose prevention programs?

I do not think we are doing anything too far outside the box. We have a way to save a life; it is simple, so let’s give people naloxone. A program that prioritizes equipping, training, and empowering individuals who use opioids with naloxone is going to make the highest impact on saving lives. Training staff, family members, EMTs, and law enforcement are all pieces of the puzzle. But until we as a system recognize that the people on the front lines are the ones who use themselves, we will just be sticking a bandage on a traumatic wound.

I keep hearing that other housing programs and shelters are not doing it. I would urge them not to be intimidated. Yes, there is a component of cost. But you are talking about the cost of saving people’s lives, and it is not that much. It does not need to be as intimidating as people treat it.

I have heard a lot of parallels between the AIDS crisis of the late 1980s and the current opioid crisis. There’s so much stigma within agencies, within families. Let’s bring it to light, equip people adequately, and talk about it, and then we will be in a much better place.

Publication Year

Alan Marzilli, Homeless and Housing Resource Network
Last Updated: 09/14/2017